I’m not a perfect mom.
I don’t do Pinterest birthday parties and I’ve heard my favorite Spanish ‘safe-swear’ come out of my son more times than I care to confess.
Sometimes I serve frozen fish sticks and tater tots right before collapsing on the couch for an hour while the teens eat alone, and honestly most days you can’t see Zion’s bedroom floor due to the mounds of toys, books and laundry he insists on gathering there and then jumping into like a pile of leaves.
Sorry if that shatters any sparkly, ethereal images you had of me.
But one thing I have done perfectly up to this point is fight giant insurance companies on behalf of my son who has autism….and won.
I adore a good challenge.
Usually to a fault.
But now that I have a 50-hour a week career and have become an only-parent yet again, I am tired.
In the story of David and Goliath, I don’t feel much like David anymore.
I am more like Maxine from the Hallmark cards.
Bite me, Goliath.
But seriously, this David now has an army. I don’t fight alone anymore. There is a host of beautiful people who have come into our lives to support us and give respite the past 2 years. So if I have to fight, I certainly can.
I just prefer not to.
Just incase you aren’t aware, every year I purchase insurance coverage through my employer which covers Zion’s ABA therapy for 180 days per year. This leaves a gap in coverage that requires a secondary policy. Thanks to Obamacare, (no I don’t care how you feel about this, it has helped us immensely) the past several years I have been able to purchase a child-only policy through an insurance company which provides the additional coverage for the ABA therapy Zion receives in lieu of public school.
These insurance companies are mandated by federal law to provide payment for these services.
Sounds good on paper.
For three years in a row, this has put the insurance company out of business.
First Wellpoint, then Assurant, now coming to a household near you in 2016…United Healthcare.
And honestly, I get it.
What do you expect?
They are paying-out close to $180,000 a year in claims for my son to receive this therapy.
Even with my premium, co-pays and deductible, I am paying a tenth of that. Which don’t get me wrong, is a veritable crap-ton of money for me, but it’s not even scratching the surface of a $180,000 payout.
So at some point, you just have to face the fact that this is bad math.
So in 34 days, bye-bye United Healthcare.
Thanks for the memories, but apparently it’s not you…it’s me.
To add insult to injury, my employer sent me a letter about a month ago explaining that their privately-funded insurance company has decided to age-cap ABA coverage. Once a child reaches the age of 7, they will no longer be eligible for ABA-related coverage.
Zion is 12.
But because my employer is kind and generous, they are grandfathering Zion into 2017. He will be covered for the first 180 days of 2017, and then his autism-related eligibility will also be termed.
So we have some moving and shaking to do.
Our options are these:
- Fight like hell. Advocate, petition, argue, sue, spend thousands on legal fees, exhaust, scream, cry, cuss, etc. Then lather, rinse, repeat…for God only knows how long. Basically years 2008-2014. Um…pass.
- Purchase a different policy. There is a child-only policy available to Z that will cover him for another year. It will cost almost triple what I’m paying now and we would have to live in a box…and if that were my only option, I would certainly make it happen. But we enjoy plumbing and soft skin, so we’re opting for choice #3.
- Transition Zion into public school. Sweet Lord. You may recall that we tried this in 2013, and it was a bit of a disaster. Remember that scene in Parenthood where Max shattered the aquarium in the classroom? Add in nakedness, fleeing, 300 kids in a school cafeteria, and a few good sprays of urine, fire-hose style, and that was Zion’s final public school stage production. (Hey, go big or stay home.)
Before you lose too much heart folks, there is hope.
Actually lots of it.
I have a meeting tomorrow morning with the special education director of a completely different school district than we attempted the transition to in 2013.
Aka my hometown.
I have spoken to parents of children who are very similar to Zion, whose kids have had great success in a newly designed classroom in the middle school that has an ABA trained teacher, 3 assistants, and very few students, making the student/teacher ratio 3:1.
Granted, Zion’s current programming provides a ratio of 1:1.
But he has grown. And I have great hope that this environment will work.
If this is a good fit for Zion, I have some decisions to make. I am already in the process of selling our home and moving back to my hometown. (It is about 20 minutes east.) Ideally, I would like to begin this transition in January.
Like January 2017.
But he does have insurance coverage through my employer for the time being incase this scenario doesn’t work.
There are also many other great things in the works right now that I will be sharing at some point over the next few months.
Consider yourself baited.
So I am asking for prayers. And love and good energy and encouragement. I am going in there tomorrow, calm and kind, with my Erin Brockovich A-game on reserve. And I am expecting great things.
Oh and if you know anyone who would like to buy a very cute, freshly remodeled ranch home, call me.
In the mean time, I will be in the superintendent’s office tomorrow brushing up my slingshot.